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Feature BMJ Investigation

Gender dysphoria in young people is rising—and so is professional disagreement

BMJ 2023; 380 doi: https://doi.org/10.1136/bmj.p382 (Published 23 February 2023) Cite this as: BMJ 2023;380:p382

Linked Feature

Gender identity services in the UK are on pause as evidence comes under scrutiny

Rapid Response:

Concerns about potential harms of medicalising children and young people with gender dysphoria must be openly discussed within professional bodies, universities and the NHS

Dear Editor

The BMJ is to be applauded for its thorough and balanced exploration of the evidence underpinning the current management of transgender youth in the US and contrasting this with approaches in Europe.

The article gives a historical perspective on the advocacy group WPATH (World Professional Organisation for Transgender Health) which has taken upon itself to provide ‘the standards of care’ required for treating this patient group. It explores the origins of the ‘Dutch Protocol’ for puberty blockers, describing how it was based initially on a very small number of children and makes explicit that the researchers were funded by the makers of the drug that was subsequently used on many of these children.

The article emphasises that the current guidelines advocated by WPATH and others are not guidelines in the modern accepted sense of the word i.e. underpinned by rigorous systematic reviews and recommendations linked to the strength of evidence. WPATH’s recommendations lack a grading system to indicate the quality of the evidence and still rely substantially on consensus opinion - they should not be used uncritically by clinicians.

CAN-SG, a group of clinicians who have become increasingly concerned at the rapid rise in medicalisation of children and young adults with gender dysphoria in the U.K., welcomes this article and calls for greater awareness of the potential harms of a solely affirmative approach. These concerns need to be openly discussed without fear of being labelled ‘transphobic’ in professional bodies, universities and the NHS.
The risks of medicalising an increasing proportion of the U.K. population (up to 2% identified as ‘trans’ in last census) and the costs of this approach must be carefully considered by medical leaders and health policy makers and weighed against the potential benefits of alternative approaches which provide non-invasive care for this population.

Dr Louise Irvine General Practitioner (retired), Professor David Pilgrim Chartered Clinical Psychologist, Dr Lisa Davies Consultant Child and Adolescent Psychiatrist, Dr Tessa Katz General Practitioner, Dr Robin Ion Registered Mental Nurse, Dr Angela Dixon General Practitioner, Dr Shahana Hussain Consultant Child Psychiatrist, Stella O’Malley Psychotherapist, Dr Catherine Bright Consultant Psychiatrist Learning Disability, Dr Juliet Singer Consultant Child and Adolescent Psychiatrist Dr David Bell Retired Consultant Psychiatrist and Psychoanalyst, Dr Maria Atkins Consultant Psychiatrist, Dr Aileen O'Brien Consultant Psychiatrist, Dr Az Hakeem Consultant Psychiatrist, Dr Lenny Cornwall Consultant Psychiatrist

Competing interests: All authors are members of CAN-SG.

02 March 2023
Louise Irvine
General Practitioner (retired)
Professor David Pilgrim Chartered Clinical Psychologist, Dr Lisa Davies Consultant Child and Adolescent Psychiatrist, Dr Tessa Katz General Practitioner, Dr Robin Ion Registered Mental Nurse, Dr Angela Dixon General Practitioner, Dr Shahana Hussain Consultant Child Psychiatrist, Stella O’Malley Psychotherapist, Dr Catherine Bright Consultant Psychiatrist Learning Disability, Dr Juliet Singer Consultant Child and Adolescent Psychiatrist Dr David Bell Retired Consultant Psychiatrist and Psychoanalyst, Dr Maria Atkins Consultant Psychiatrist, Dr Aileen O'Brien Consultant Psychiatrist, Dr Az Hakeem Consultant Psychiatrist, Dr Lenny Cornwall Consultant Psychiatrist
Clinical Advisory Network on Sex and Gender
London, UK